By Michael Sasser, PharmD
When people hear the words "Post-Traumatic Stress Disorder," or PTSD, their minds most often go to images of soldiers returning from war. But PTSD can hit anyone who has been through a traumatic experience, and that includes serious illness.
Studies have found that cancer patients are at a particularly high risk for PTSD. According to several of these studies, 8-29% of adolescents and young adults with cancer experience cancer-related PTSD. These rates can be five times higher than patients of similar age without a history of cancer. One study found that when compared to siblings with no history of cancer, cancer patients have four times the risk as their siblings for PTSD.
Thankfully, there are many effective treatments for PTSD, but early identification is paramount in prompt and effective treatment.
What are the risk factors for cancer-related PTSD?
There are several factors that can contribute to a higher risk of developing cancer-related PTSD, but it's important to note that the presence of these risk factors does not necessarily mean someone will suffer from PTSD. Similarly, their absence does not guarantee a patient will not.
Risk factors include:
- Advanced Disease
- Young Age
- Female Sex
- Lower Education
- Reduced Socioeconomic Class
- Recently Completed Treatment
- History of Previous Trauma
- History of Mental Health Issues
- Lack of Social Support
What are the symptoms of cancer-related PTSD?
Cancer-related PTSD can present in many different ways, and patients with PTSD may experience flashbacks, anxiety, or combative behavior in response to reminders of a traumatic event.
Here are only a few common symptoms:
Intrusion symptoms AKA “Re-experiencing symptoms”: Intrusive memories of the event, such as unwanted thoughts, nightmares, or flashbacks.
Avoidance symptoms: Avoiding internal thoughts or feelings related to the event. This includes activities, people, or situations that remind them of the event.
Negative mood: Difficulty experiencing positive emotions and decreased interest in social events. Patients will often feel guilty for having cancer and for the pain or suffering their loved ones experienced.
Lack of arousal/reactivity changes: Initially, this may present as irritability, but can often evolve into self-destructive behaviors such as drug abuse, decreased concentration, feeling on edge, and trouble sleeping.
Depersonalization: Feeling disconnected from one’s body.
Derealization: Feeling as if the world is not real.
How can we treat cancer-related PTSD?
Trauma-Focused Psychotherapy offers many non-pharmacological treatment options for PTSD.
Cognitive-behavioral therapy (CBT) combines cognitive and behavioral components to help individuals re-evaluate thinking patterns and transform “distorted” thoughts into more balanced and effective thinking patterns. CBT targets current problems and symptoms and is typically delivered over 12-16 sessions in either individual or group format.
Exposure-based therapy assists the individual in confronting the traumatic experience, through prolonged exposure therapy—12 sessions including breathing retraining, education about common reactions to trauma, and processing traumatic material—and/or written exposure therapy, where individuals write about their traumatic event in response to specific prompts.
Eye movement desensitization and reprocessing (EMDR) involves imagining the trauma and manipulation of the visual field to decrease anxiety associated with the memory.
But there are also several types of pharmacotherapy that can be used in isolation or in conjunction with trauma-focused psychotherapy. These include serotonin reuptake inhibitors, antipsychotics and alpha-adrenergic receptor blockers.
For most PTSD patients, trauma-focused therapy is recommended prior to initiation of pharmacotherapy or other types of therapy, and has been extensively studied and found to be effective in the treatment of PTSD.
What do I do if I think I have cancer-related PTSD?
Talk to someone. Tell your doctor.
PTSD isn't something that anyone has to face alone, and there are treatments that can help. Unfortunately, many symptoms of PTSD go ignored by the individual or are missed by family and friends. But it is important to communicate with your healthcare providers in order to treat PTSD early and effectively.
The most effective treatment for cancer-related PTSD is the one centered around you!
To learn more about Behavior Health Services at Sarasota Memorial, including inpatient and outpatient treatment, click here. For more information, a free clinical assessment, physician referrals or help connecting with local mental health resources, please call 941-917-7760.
To learn more about the world-class collaborative care that patients receive at Sarasota Memorial Hospital’s Brian D. Jellison Cancer Institute, click here. And to learn more about the Thrive Integrated Oncology Program, providing support and wellness services both during and after treatment, click here or call 941-917-7827.